FPH UI Doctor Researches Dengue Multifirus Infection to Determine Patient Initial Intervention Steps

“The main determinant of the severity of dengue hemorrhagic fever in adults is the low platelet count during the infection period,” said Ikhwan Rinaldi opening his dissertation entitled The Relationship Between Patient Characteristics, Hematological Status, Liver Function Status, Coagulation Status, and Dengue Multivirus Infection with Nadir Platelet Count in Adult Dengue Infection Patients, at an open session for the promotion of doctor of Epidemiology FPH UI, Tuesday, July 4, 2023.

Dengue hemorrhagic fever or DHF is a disease caused by the dengue virus via the Aedes aegypti mosquito. Various literatures have found the mechanism of decreased platelet count in dengue infection. However, no studies have examined the relationship of these factors with a nadir platelet count ≤20,000/µL simultaneously and thoroughly in one study. Therefore, this study was conducted to examine the relationship between patient characteristics, hematological status, liver function status, coagulation status, and multiviral infection with a nadir platelet count ≤20,000/µL. The Ikhwan will also create a prediction model based on these factors for a nadir platelet count ≤20,000/µL during treatment.

This study was a retrospective cohort study with a total sample of 210 subjects who were patients ≥ 18 years of age, had positive dengue serotype PCR results, met the diagnostic criteria for dengue fever or dengue fever, had complete laboratory data from admission to discharge, and were admitted during the acute phase (onset of fever ≤ 4 days). The results of the dissertation from Ikhwan Rinaldi showed that the proportion of dengue fever subjects who had a nadir platelet count ≤20,000/µL was 18 out of 121 subjects (14.9%). It was concluded from the results of his research that the variables that had a significant relationship with the nadir platelet count ≤20,000/µL were low monocyte counts (<465.61/µL), low platelet counts at admission (<161,000/µL), high SGOT levels (≥50.50 U/L), high thrombomodulin levels (≥773.3550 cells/µL), and time-dependent NLR. While the most applicable scoring model is a scoring model based on the results of multivariate analysis without coagulation status with an AUC of 0.833, a sensitivity of 83.3% and a specificity of 68%.

Based on his findings, Ikhwan suggested further research to increase the validity and accuracy of the study by conducting a prospective cohort study that could observe changes in laboratory parameters over time during the treatment period. In addition, further research is also recommended to increase the precision and spectrum of research variables by using more samples and higher power. Prof.

“The research that I am conducting can have direct benefits for patients, namely to determine early intervention for patients detected with dengue, such as determining the amount of fluid given at the beginning of the treatment period,” said Ikhwan conveying the direct benefits of his dissertation results to the examiners.

The doctoral promotion open session which was held in a mixed manner was chaired by Prof. drg. Nurhayati Adnan, M.P.H., M.Sc., Sc.D., with Promoter Prof. dr. Mondastri Korib Sudaryo, M.S., D.Sc., and Co-promoter Dr. Besral, S.K.M., M.Sc., and Prof. Dr. dr. Suhendro, SpPD-KPTI. The members of the examining team in the doctoral promotion open session were dr. Syahrizal Syarif, M.P.H., Ph.D.; Prof. dr. C. Suharti, SpPD-KHOM., Ph.D.; Dr. Soewarta Kosen, M.D., M.P.H., Dr.PH., and Prof. dr. Abdul Muthalib, SpPD-KHOM.

Ikhwan Rinaldi successfully passed and holds a Doctorate degree in Epidemiology with cum laude graduation and a 3.91 GPA. Ikhwan is the 100th doctoral graduate in Epidemiology and the 364th overall doctoral graduate at FPH UI.